Elly Teman, an Israeli anthropologist at the University of Pennsylvania, has been researching this question -- and other issues relating to surrogacy -- for the past decade. In her recently published Birthing a Mother: The Surrogate Body and the Pregnant Self, Teman explores the cultural assumptions about surrogacy, debunking some along the way, as well as misunderstandings that surround the controversial process.
"There is a common belief that surrogate mothers bond with the baby they carry, and later decide to keep it," she said in a recent interview. "The truth is that less than one-tenth of 1 percent of cases end up in court. Surrogates don't bond with the babies. They bond with the women -- the women they are making into mothers."
Teman's research focused on Israel, one of the few countries where surrogacy is legal and also tightly regulated. Unlike in the United States, where surrogacy is legal only in select states, close distances between the surrogate and the intended mother in Israel meant that the women were constantly interacting.
Teman followed these women as they embarked on an exciting and emotionally charged journey that transformed them from strangers to something much more complicated.
"In the U.S., the surrogate could be in Oregon and the intended parents could be in New York, so most of the communication is done through e-mail and the phone," she said. "But in Israel, the intended mother sees the surrogate's belly growing, and she goes with her to ultrasound appointments. The Israeli version is intensified because they see each other so often."
In Israel, some of the intended mothers even started to develop symptoms of pregnancy -- rashes, bloating, weight gain -- because they were so close to the women who were carrying their genetic child.
"People would say that the intended mothers were glowing," Teman said, "and for them, feeling 'a little pregnant' meant a lot."
The costs of surrogacy are prohibitive for many couples in the United States, often running upwards of $100,000, which includes the cost of in-vitro fertilization. In Israel, where IVF is covered by the state, the cost is about half.
Surrogacy has been legal in Israel since 1996; the first baby born to a surrogate mother came two years later. The bill to legalize it passed through the Knesset in record time, and as a result, Israeli law is very strict in regulating the process.
Criteria for the surrogate, as well as the intended couple, are determined by a state committee.
And the committee is strict: a woman must be married to be eligible, and she needs to have gone though at least seven failed IVF attempts or have other medical problems to prove her infertility.
The United States, however, has no such legal safety net. Surrogacy in New York is illegal, but in Pennsylvania, for example, it is not expressly prohibited, which means that women often cross state boundaries to contract surrogates.
California, meanwhile, is a "mecca" for surrogacy, Teman said, though it isn't regulated at all. The result is that couples from around the United States, as well as countries throughout Europe and Japan, often travel there to contract a surrogate mother, but individual agencies -- rather than the states themselves -- are then responsible for screening.
Also, "there is no back up in court. No one knows what will happen in a court of law if the surrogate wants to keep the baby," she said.
Money and the Mitzvah
Teman, who was born in New York and raised in Portland, Ore., immigrated to Israel with her family at age 12. She studied at the Hebrew University and became interested in the issue of surrogacy after meeting a woman who was born with ovaries, but no uterus, and was looking into options.
Teman also said that her research -- which was conducted between the years 1998 and 2006 -- was made possible because of Israel's liberal approach to the issue. The state's Jewish character, she noted, caused it to go "very far" in legislating surrogacy.
"Surrogates are doing it for the money and for the mitzvah," she said. "These two don't contradict each other, and they don't take away from each other. That's sometimes hard for people to digest.
"People think that if there's money involved, then it's a business transaction, and if there is no money, then it's a mitzvah. But the surrogate gives more than money can buy."